Submit completed form and all supporting documents to smartpass@ibigroup.com.2022 Smartpass Agreement • January 25th, 2022 • California
Institution Name (Provide DBA or prior institution name, if applicable) Billing Address (Street, City, State, ZIP Code) Federal Tax Identification Number (If your organization has federal tax-exempt status, provide your tax ID number and any supporting documents. For more information on acceptable documents, visit www.irs.gov/charities-non-profits/exempt-organizations-affirmation-letters). Coordinator Contact Information (Name, Title, Email Address, Phone Number) Primary Coordinator: Back-up Coordinator: Miscellaneous Do you require a Purchase Order to process payments?If yes, please include the PO number here: FOR VTA USE ONLY(To be completed by VTA staff) May VTA identify you as a member of the SmartPass Program in promotional material? SmartPass Category Are you required by a local city ordinance to enroll in a transit program such as the SmartPass Program? Address of Each Participating Facility Headcountper Faciliy† Service Level Annual Rateper Person Amount a. b.
Submit completed form and all supporting documents to smartpass@ibigroup.com.2022 Smartpass Agreement • November 2nd, 2021 • California
Institution Name (Provide DBA or prior institution name, if applicable) Billing Address (Street, City, State, ZIP Code) Federal Tax Identification Number (If your organization has federal tax-exempt status, provide your tax ID number and any supporting documents. For more information on acceptable documents, visit www.irs.gov/charities-non-profits/exempt-organizations-affirmation-letters). Coordinator Contact Information (Name, Title, Email Address, Phone Number) Primary Coordinator: Back-up Coordinator: Miscellaneous Do you require a Purchase Order to process payments?If yes, please include the PO number here: □ Yes □ No FOR VTA USE ONLY(To be completed by VTA staff) May VTA identify you as a member of the SmartPass Program in promotional material? □ Yes □ No SmartPass Category Are you required by a local city ordinance to enroll in a transit program such as the SmartPass Program? □ Yes □ No Address of Each Participating Facility Headcount per Faciliy† Service Level Annual Rat
